You start with a tube...

July 8, 2012

To all those who travel here: Eric Aadhaar passed away, peacefully and with his beloved at his side, as the sun was rising on Sunday, July 8, 2012. His wisdom, humor, and compassion helped so many on our road to nourishing ourselves and the ones we love. His last post can be found on his personal blog, Entropy and Light: The Last Post.

For information on tube feeding and using real food through the tube, please scroll to the menu

March 22, 2012

Finally, after all that, it's here. I hit the 'go' button on publishing just 24 hours ago and only now am I remembering to mention this fact here. Life goes on, with its other plans for us too, eh?

Anyway, for those that keep in touch by following my doings here, the book is properly real, and ready for you to read. Typos and all. I found a couple, and then though - fixing these means more days and days of not having it out there for people to use, and besides, it will never be perfect. It sure isn't perfect, but I know myself well enough to know that I could spend forever polishing this doorknob and never opening the door ...

So I commend this book to you. It is a fruit and labour of love, made possible only by the sharing, generous and supportive hordes I have encountered online and elsewhere along my own tubie journey, and that means you too. So thank you. All I hope is that it makes a positive difference to someone, somewhere.

You can visit the website, peek inside the book, and click through to the store to order your copy right here:

It was Leonardo da Vinci apparently who said that "Art is never finished, it is merely abandoned" and that surely applies to works like this one too. It has to find its own way in the world now. Please enjoy; and humbly, thank you.

March 14, 2012

Below is a sneak preview: an excerpt from Complete Tubefeeding (Everything you need to know about tubefeeding, tube nutrition and blended diets) , due to be published any day now.

1. A
brief history of tube feeding

(actually
it's a longer history than you might imagine)

“The
need to avoid prolonged starvation in patients is well recognized.”

(from the
introduction to the American Gastroenterological Association's
official recommendations on the use of enteral nutrition.)

These
days when we get a g-tube or other sort of enteral feeding device
placed, we go to a modern shiny hospital with highly-trained staff,
expensive hi-tech equipment and machines that go 'Bing!' Most tubes
are placed in a sterile operating theatre with a surgeon and an
anesthetist, maybe some radiological equipment, and all sorts of
brilliant tools. The devices themselves are made of state-of-the-art
materials; high grade flexible silicon and specialized plastics, and
often have quite the sci-fi look about them. Then you
will be introduced to the truly amazing advances in synthetic
nutritional products – they come in a bewildering array of
different types and brands for different patient profiles and needs
and yes, they really are a product of the space age. So we tend to
think that the miracle of tube feeding is a pretty recent
development. Well, yes and no.

In
fact, it seems using tubes for feeding patients goes back at least
3500 years to ancient Greek and Egyptian civilizations. Papyrus
evidence suggests that Egyptian physicians used reeds and animal
bladders to rectally feed patients things like wine, milk, whey,
broth and so on to treat a range of complaints. Rectal feeding would
remain the artificial feeding method of choice for many thousands
of years because of the difficulties in accessing the upper GI tract
without also killing the patient. Some things in medicine have
hardly changed at all, as not killing
the patient remains important to
this day.

There are some
reports of tube feeding in the 12th century but the
acknowledged Western pioneer was a fellow called Capivacceus who in
1598 used a hollow tube with a bladder attached to one end, filled
with some form of nutrient solution, down as far as a patient's
esophagus. The beautifully named Aquapendente used a form of
nasopharyngeal tube in 1617 – the forerunner of our NG tubes, but
only going as far as the pharynx. A guy (they're all guys I'm fairly
sure) called Von Helmont devised a flexible leather tube for feeding
into the top of the esophagus in 1646, which must have been a pretty
good improvement in patient comfort over things like hollow
whalebone. Then in about 1710 it was suggested that such tubing
might be used to reach all the way to the stomach.

For
the rest of the 18th and the 19th centuries
gastrointestinal feeding was practised here and there but I suppose
due to the discomforts and difficulties of keeping a tube down
someone's throat - or whatever other reasons - rectal feeding was a
more widespread and accepted practice. Some of the oro- and
naso-feeding contraptions were quite sophisticated, for example in
1790 a physician called Hunter was doing oro-gastric feeding using a
whale bone covered in eel skin attached to a bladder pump to feed his
nutrient solutions. He is reported as using mixtures of jellies,
beaten eggs, sugar, milk and wine. Anyone who's had a naso-gastric
(NG) tube as I have will tell you it's a pretty awful feeling thing,
even worse I would imagine back then, using the sorts of materials
available before high-tech plastics and silicone. But imagine an
oro-gastric tube! This probably explains why it seems NG tubes
increased in relative popularity for gastrointestinal feedings as
time went on. These tubes still most often only extended down as far
as the fauces (the narrow part past the back of the mouth towards the
pharynx) and in the 1870 mixtures such as thick custard and mashed
mutton were forced through these tubes, or combinations of warm milk,
beef broth, eggs, and medicines appropriate to the symptoms of the
patient.

These
sorts of feedings weren't just for patients who couldn't eat, mind
you: according to physicians such as Coulton naso-pharyngeal feeding
was also inflicted upon 'fasting girls and spoilt children who, when
ill, refuse food'. In addition to tubes, devices that looked a bit
like a teapot with a very long spout were made to force-feed patients
in mental institutions mixtures of milk, egg, beef tea and wine
thickened with arrowroot.

When
US President James Garfield was shot in 1881 he was kept alive a
further 79 days by being rectally fed a blend of beef broth and
whisky.

BONUS History
Trivia: Alexander Graham Bell also devised a very early sort of metal
detector to attempt to find the bullet inside the President, but it
failed to work – it was reading the bedsprings instead, and as
metal bed frames were very rare then, no-one at the time could work
out why the device malfunctioned. PLUS: One of the doctors trying
to save the President had the given name of 'Doctor”: Dr Doctor
Willard Bliss.

Rectal
feeding does (thankfully) seem finally to have gone out of fashion
although I am told that some medical students these days, upon
learning of things like James Garfield's ordeals discover all over
again that colonic absorption is a very fast way to get drunk.
Apparently. Don't try it though, OK? Even if you are in
college.

But
gastrostomy – inserting a tube through the skin directly into the
stomach – was not seriously suggested until 1837, and as far as I
can ascertain, not attempted until 1845. Early attempts were
apparently 'associated with many complications' (we can use our
imaginations I think) so naso-gastric feeding remained the way to go
for a while yet.

Now
around about 1910, two things were notably happening at roughly the
same time. A man called Einhorn was experimenting with
nasally-inserted feeding tubes going all the way into the jejunem
(what we would call now an NJ tube), that is, all the way past the
stomach and into a part of the upper intestines. Elsewhere, research
was going on with feeding dogs and trying to maintain a nitrogen
balance (essential for healthy survival) by using solutions of
hydrolysates. They did not experiment on humans as at this time
hydrolysates were thought to be at least indigestible and possibly
poisonous to humans. This research led in turn to better
understandings in using predigested proteins and the role and use of
amino acids, which would in turn help pave the way for modern
synthetic enteral formulas. In the 1930s some doctors were starting
to pioneer the use of hydrolysate-based formulas (now for humans) in
NJ feeding for those whose stomachs were compromised in one way or
another. These mixtures used things like a casein hydrolysate;
essentially skim milk treated and fortified with acid, pepsin, salt,
bicarb soda, dextrose and various vitamins. Even today this is a
recognizable outline of the ingredients on the side of some cans of
commercial formula.

One of the big
issues with percutaneous gastrostomies – sticking a tube through
the skin – was the problem of infection. Until the 1940s there
were no really effective antibiotics so there was a bit of a
disincentive to do a gastrostomy when an NG tube, although a slightly
horrible experience for the patient, could do the job. But with the
advent of modern antibiotics came an explosion in the sorts of
surgeries that would be attempted, and would eventually become
commonplace. At around this time too, some doctors began thinking
that those experiments with more broken-down formulas for jejunal
feeding might be applicable to gastric feeding scenarios as well …
and now we can see the modern age rushing in upon us. Interestingly,
much of the push to develop very broken-down formulas came about in
attempts to meet the needs of patients whose GI systems had nearly or
totally shut down – the idea was to feed them more than just
glucose intravenously – so the early 20th century also
saw the start of the development of central-line IV feeding (where
the patient is fed not into the GI tract but directly, intravenously
into the blood stream), called Parenteral Feeding.

Fairly
quickly, these broken-down, synthesized formulas for enteral feeding
became the norm; for a short while at least. It was quite an
exciting time for the pioneers, who even went so far as to experiment
with feeding patients into the jejunem during surgery. In
1949 polyethylene tubing was first used, and the first enteral
feeding pump was developed. But problems of patient tolerance of
these broken-down feeds seemed to be commonly arising. In an effort
to address this, a sort of return to first principles took place:
Hospital kitchens were asked to mimic a normal diet by finely
pureeing and liquefying a blend of regular cooked foods, and
naturally enough they were generally well-tolerated. The down sides
in the hospital environments then though were cost – it was
labour-intensive to prepare such foods, and (perhaps ironically) a
hospital environment proved a difficult place to keep such foods free
of contamination, as compared to sterile synthesized formulas.

In
the 1960s, advances in the understanding of the role of amino acids
led to further studies designed to see if new formulas could be
devised to support patients without the side-effects those early
attempts produced. This was supported hugely by the space program,
with NASA getting very excited. They could see the great potential
in an astronaut 'food' that was concentrated and gave a low fecal
residue. These 'elemental diets' had many advantages for the nascent
space flight program, in that they stored and transported well, had a
very high nutrient density (so were very light), were very soluble so
reconstituted easily, maintained an adequate nitrogen balance, and
were easily tweaked and adjusted to meet an individual's specific
metabolic needs better. But this stuff tasted so bad that the
astronauts just refused to eat it. Even today, astronauts eat a
largely natural diet, to the extent of taking fresh fruit and tasty
baked brownies up with them. Tortillas make awesome edible,
low-crumbing zero-gravity frisbees also.

Of
course, patients taking their nutrition via tube do not really have a
problem with how the solution tastes, and as more and more advances
were made in materials for tubes, tube placement surgery and feeding
formulas, the formulas derived from the NASA-led research became the
standard go-to for tube feeding nutrition. But there was also a sort
of medical research arms-race going on, with rapid advances in
Parenteral Nutrition. For a while TPN (Total Parenteral Nutrition)
was the one attracting all the attention, but quietly research
continued in the roles of amino acids and other food constituents, in
understanding digestion, absorption and gut physiology. Advances in
the development of enteral feeding formulations, tube technology, and
the demonstrated lower incidence of complications, lower cost and
ease of access eventually moved enteral feeding to the forefront,
where it remains the first choice option today.

Something
else was going on in the 60's and 70's that related to tube feeding
also – far fewer people were dying. Partly this was the result of
a slow cultural change that had been gathering pace over the century
– we seemed to become a lot less comfortable with allowing death to
happen if it was at all avoidable, regardless of circumstances, in
much of Western civilization – but a very large factor was
technological. The miracles of antibiotics, amazing new drugs,
advanced diagnostic and surgical techniques all combined to allow us
to save lives that we never before would have been able to save.
Serious accidents and injuries that once killed routinely no longer
do. Life-limiting illnesses are still on the rise but with advances
in treatment and diagnostics patients are tending to live longer.
This modern phenomenon is especially pronounced at either end of the
age spectrum, with the very young – the very prematurely born even
– and the much older citizen.

Of
course, saving all these lives means many more people living with
serious impairments, a very common such impairment being the
inability to eat. Since the last few decades of the 20th
century, we've seen an explosion in the number of feeding tubes
placed right across the world, most pronounced in countries like the
USA. Actual numbers are hard to come by. According to an article
published in 2005, there were around 344,000 people using a feeding
tube at home in the USA, and the article quoted a 1995 study
suggesting that 120,000 patients in long-term care were using feeding
tubes also. One thing we do know is that tube placements have
continued to grow faster than the population, so it would be
reasonable to think there might be half a million to a million people
using feeding tubes in the USA alone right now.

To
go along with the boom in numbers of tube-fed patients, we now have
commercially available enteral formulas in hundreds of different
variations; many are very similar, just made by different
manufacturers and to different calorie densities, but there are
others designed with specific diseases and patient needs in mind.
Most recently though, there has been an increasing uptake, driven in
the main by parents and carers of tube-fed children and by adult
patients themselves, in returning to a more natural food-based diet,
often referred to as a blenderized, blended, or
pureed-for-gastrostomy diet. It's almost as if we are somehow coming
full circle.

February 19, 2012

(Below is an extract from my soon-to-be-published book on all things tubefeeding-related, since so many people are asking about herbs and spices lately)

Outside of the world of naturopaths,
herbalists and other natural health practitioners, there are a great
many everyday culinary herbs and spices that we have known for
millenia assist digestion and can help to resolve issues faced by
tubies. Such foodstuffs have been used as medicine in various
cultures since well before the dawn of written history, and we can
take much from both the traditional wisdom and what modern science
has discovered about their benefits and uses. Also, they can make a
blend smell and taste that much more pleasant.

Herbs and spices are, and are not, like
modern medicines. Most modern medicines in fact trace their
development back to plant materials, aspirin derived from the bark of
a willow tree being perhaps the most famous example. Herbs and
spices can be very complex in their actions, but may be used to
target specific complaints too, in the same way modern drugs are.
Many however are simply said to be 'supporting' digestion. Some are
said to 'regulate' digestion. These descriptors might mean a herb
has opposite effects on a different person or on the same person at
different times depending on what the body requires to move back to
its best possible state of health: for example, promoting looser or
firmer stools, depending on what is going on at the time. So
'prescribing' is not the best way to think about using herbs,
focussing instead on using a wider selection to promote overall
wellbeing and digestive health.

Which to use, how much, how and when?
There can be no one good answer, but tips are given for each below.
Think of it this way – use the herbs and spices as you would in
cooking: go for the same pleasing taste and aroma concentrations. It
is no accident that coconut and curry spices go so well together;
each component supports the digestion of the other. The aromatic
sweetness of cardamom in a yoghurt lassi drink can eliminate the
mucus-thickening effects of the dairy. Those classic Italian herbs
like basil, oregano, and so forth are all perfect to stimulate
digestion of their typical partners in pasta, olive oil, tomatoes and
so on. The culinary traditions are our very best guide to combining
herbs and spices with foods and blends, but don't be afraid to
experiment! Keep in mind that herbs and spices are string-tasting
and strong-smelling because they contain very powerful compounds, and
you don't want to overdo it. Again, the kitchen traditions are your
guide. Start out with ordinary 'recipe' amounts, and if you're
wanting to increase the dosage for specific effect, do so slowly and
keep a weather eye on any potential adverse reaction. And give your
herbs and spices a break from time to time. As with foods, the very
same thing over and over is not ideal for us, and taking a break acts
to refresh our response to the medicinal and nutritive effects.

Do please keep in mind this is a
general guide only; I am not offering medical advice. In fact in
most countries it is not permissible by law to make any specific
health claims about herbs, spices or foods. If you can, consider
seeking out a good herbalist, naturopath or trusted professional to
help guide you along the way with more specific advice.

Anise

Sometimes called aniseed, and not to be
confused with star anise (something different entirely), anise is
related to dill and fennel. The seeds have a sweet rich licorice
taste and aroma and help to digest rich foods, promoting good gastric
motility and lessening bloating, cramping and flatulence. It
regulates digestion, making it useful for both diarrhea and
constipation. You can blend the seeds or make a tea and use that in
blends or (cooled) on its own.

Basil

As well as having a mild calming and
soothing effect on the mood and mind, basil is the natural
accompaniment to tomatoes; it may aid in their digestion and
absorption. Also helpful for stimulating the appetite, used for
promoting gastric motility and relieving nausea. Use the fresh or
dried leaf.

Black Pepper

Yes, common black peppercorns like
you'll find in pretty much every kitchen in the developed world is a
wonderful appetite and digestive stimulant; specifically it
stimulates secretion of pancreatic enzymes. It also helps with
constipation and flatulence and can help improve circulation. You can
just toss a few peppercorns into the blender or grind them fresh from
your pepper mill.

Caraway

Caraway seeds are excellent for easing
gas bloating and flatulence, can assist with colic symptoms and may
aid in the prevention of reflux. The fresh leaves can be used also,
directly in blends, as with the seeds. Caraway has been said to
promote milk production in nursing mothers and assist with symptoms
of bronchitis as well. It is ideal that caraway seeds be heated prior
to ingestion, so either toss them in with cooking food (the perfect
accompaniment to pumpkin) or give them a very quick dry-roast on a
pan or skillet before grinding them. Uncooked caraway seeds may
escape the blender blades and are just the perfect size to lodge
sideways in a button valve, so consider grinding your dry-roasted
seeds separately first.

Cardamom

Cardamom is a fantastic digestive
tonic, aiding gas, bloating, and gastric motility, and can relieve
stomach cramps. It can counteract the thickening of mucus secretions
often associated with dairy products, and has been shown to have
powerful anti-ulcer properties. Use the seeds freshly ground if
possible, but powdered is fine and very easy to use too.

Cayenne pepper

This is a powerful digestive and
circulatory stimulant, and definitely take care when using with
children or those with very sensitive systems. It is used to treat
indigestion, and unlike the advice generally given about avoiding
spicy foods it may be that a small amount of cayenne actually
improves acid reflux.

Chamomile

Soothes digestive upsets and provides
relief from nausea; best used as a tea, you can use chamomile tea as
a thinning liquid for your blends or bolus it (cooled) on its own.

Cinnamon

A wonderfully warming spice, cinnamon
stimulates digestion at all levels, gently encouraging bowel
movements but also acting to alleviate diarrhea. This seems to be
the spice that makes for the best-smelling vomit as well strangely
enough, with a little bit making any such unfortunate eruptions
rather less unpleasant to deal with. The bark of a tree, you can
throw the 'quills' it comes in straight in the blender or use the
ready-powdered form. Great with fruity blends especially I find.

Coriander

The fresh leaves are a good stomach
tonic, and the ground seeds also stimulate digestion and can help
alleviate diarrhea. Coriander seeds have been shown to have some
anti-bacterial and anti-fungal effects (as well as smelling and
tasting divine) so may be useful that way too. These seeds blend
just fine.

Dill

The fresh or dried tips and also the
seeds of dill are classic pairings for egg dishes and shellfish. It
helps soothe digestive upsets, especially colicky gas and flatulence.

Fennel

Fresh fennel leaves can act as both an
appetite stimulant but also then promote a feeling of fullness, very
helpful for those trying to lose weight or who suffer from hunger
pangs. It lessens gas, cramping and flatulence, Can assist with
nausea and also insomnia. The seeds or fresh leaves can be blended
easily or a tea made from the seeds.

Ginger

Fresh or dried ginger is a very useful
digestive herb, helping to speed digestion along but also calming the
stomach, soothing nauseas and acting to reduce or prevent gas,
bloating, cramping and flatulence. The fresh root has more active
compounds but there is some evidence that dried powdered ginger may
be more gentle in its effects. It can be added to blends or made
into a tea. A tea with ginger, cayenne, lemon, honey and garlic is
an excellent tonic for colds and flus.

Mint

There are hundreds of member of the
mint family, and all the culinary mints can assist with digestion,
easing gas especially that associated with consuming beans. It also
has an anti-inflammatory action. Add the fresh or dried leaves to
blends.

Parsley

Humble parsley, the ubiquitous garnish
herb, stimulates appetite and may also help with the assimilation of
nutrients. It is very high in iron and Vit C as well. Use freely
fresh or dried in blends.

Thyme

As well as being good for coughs, thyme
stimulates production of gastric secretions and mucus, especially
useful for irritated stomachs. It has antibacterial and antifungal
properties, yet also acts to support a healthy intestinal flora.

Turmeric

The fresh or dried, powdered vibrant
yellow root calms the digestive system and stimulates production of
bile and digestive enzymes. It has antiseptic properties, and
reduces intestinal gas and bloating, especially that associated with
beans and legumes. Use the fresh root or powder in cooking or
straight in the blend but take care – it can stain a nice happy
yellow colour.

This really only scrapes the surface of
the herbs and spices you might find in your kitchen already. Those
who make their own curry powders will recognise that several of these
are key ingredients in many curries, and indeed most curry mixes will
assist with digestion also. Herbs and spices are best as fresh as
possible, or in the case of powdered spices, freshly ground if you
can. Buying in small quantities from a source with a high turnover
of stock is ideal if you are able.

January 11, 2012

My dad was an Antarctic adventurer. Unsure quite what to do in life, not yet ready to settle into teaching after his University studies in maths and a diploma in education, and following a career so far speckled with odd and interesting jobs he answered an ad in the paper seeking people to join an Antarctic Expedition crew for a year. He did a crash course in meteorology, Antarctic survival stuff, and sailed for the icebound continent in 1956 or thereabouts as a 'weather guesser'. They were primitive times back then, he was only the second crew to man their station at Davis, so they inherited a one-room hut and took with them the makings of the rest of the station on board the ship, which they had to build as soon as they got there. Small crew, all men, with very limited contact via dodgy radio with the outside world for a year or more.

And of course they had to take all their own food with them. Though there could also be trying moments when one gets (for example) stuck in a blizzard that lasts 14 days with only a week's supply of food (which is how much you take for a 2-day field trip in Antarctica, just in case). Certain unpalatable truths about seal meat, dog flesh, and so on are learned too.

Huskies (the dogs they used to use for getting around back then) can live off a diet very high in seal meat, so long as you don't then eat the dogs, especially the dog's livers. Certain vitamins get concentrated to toxic levels. Fun But Obvious Fact - dead seal freezes, so the best way to cut it up is like a log; in rounds, with a chainsaw. Glad you know that now? :-) This is the Antarctic Leopard seal. They are notoriously unfriendly. Do not try to pat one.

Luckily, my father's expedition had a Frenchman in the crew who just happened to be an excellent cook. He didn't just bake bread, he plaited loaves specially, and gave them some actual variety and joy when it was his turn to cook. But of course, nearly everything that went down with them was tinned. And you can imagine the boredom of the same tinned diet over and over and over for months and interminable months in a small building with 6 or 7 others.

Which brings me to the Bloody Goldfish. That's the typically Aussie name they gave the detested Sardines in Tomato Sauce - detested not for any reason other than because there were so bloody many of the bloody little things, meaning they were a most frequent dietary item.

I've never eaten a tinned sardine in my life, and we certainly never had them in our house when I was growing up. Dad would make shuddery comic-disgust faces whenever someone said the word 'sardine' and mutter "uuurrgh Bloody Goldfish" under his breath.

One erstwhile tubie momma (her boy has successfully weaned and eats like a champ now) had a standard super-food blend she'd make involving sardines, avocado and olive oil. Yes, heavy on the fats but they're all good fats and when you have a look at the breakdown of nutrients it's an amazingly full and power-packed blend. She'd add other stuff around this but this was a very regular blend backbone.

Recently, in the course of research for my book and through life in general I've been prompted to think about including some more animal-sourced foods in my diet. I am typically a lacto-vegetarian blender you see, relying mainly on legumes, nuts, seeds and dairy for my proteins. Very very rarely I'd blend egg if it had been baked in something or if we had egg leftover from a meal for guests. Just easier when you have a vegetarian household - no meat-handling issues in the fridge or sink etc. Still, Meeta's fine with my consuming whatever as long as I'm 'clean' about it and eventually I decided I would. I'd start with these little oily fish that are so calorie-dense and so good for you.

I've spoken of it before, the advantage I have of being my own blender, and able to communicate; I can 'listen' to my own body, and in fact removing the distractions of taste and smell and all that joyous stuff around eating has made me even more keenly aware of how food feels and how my body responds to it. And it was saying it wanted sardines. Also, maybe some emu, kangaroo, and some bone broth-type stuff, probably from a cow. Emu is my favourite meat of all; if you're a carnivore and you've never tried it, seriously do yourself a favour.

Of course, I wouldn't buy the Bloody Goldfish. Apart from anything, it's hard enough finding good sustainably-fished sardines from local waters let alone ones with organic extras so good ol' spring water it was for my little tinned guys. I have eaten sardines before, but fresh luscious ones caught earlier that day, not the tinned ones, as I mentioned. They do go with tomato really well. And it's tomato season in my garden right now: here's what I blended:

Tins sardines in springwater x 2Light rye sourdough bread w caraway seeds (org, baked by me that morning), large chunk.Lettuce, various types, from the gardenTomatoes, cherry pear variety, from the gardenCapsicum (bell pepper) from the gardenBasil and marjoram, from the gardenGarlic cloves, locally grownOrganic tomato pasteEVOO, organic, from just down the road.Water.

I had an avocado in the fridge but it turned out to be what lots of chefs I know call a 'hand grenade' so its grey mooshiness is now happily feeding worms. I added a splash more oil because of this.

As food, I imagine having roasted the little tomatoes and peppers in some oil, and mushed them into the sardines on to fresh hot toasted crusty rye sourdough, with the herbs roughly chopped through and some salad leaves. Mm.

I didn't weigh or measure, and got 2 litres of pretty thick but rich and smooth not-too-fishy-smelling ochre-coloured blend that I had roughly estimate at about 35-40 cal/oz. Not too fatty, and a good spread of nice nutrients. Very 'crunchy' in the green/locavore/organic/hippy sense too if you're not hung up on the whole animal death thing. And I have to say, a couple of hours after a feed, it feels really very good.

I plan to honour the demise of a few more animals by consuming their flesh thoughtfully and respectfully in as friendly a way to them and our planet as I can in the near future. I'll keep you all appraised of any interesting developments. :-)

This is Davis station in the summer after my dad lived there. The Vestfold Hills area of Antarctica remains relatively ice-free, especially in summer. Nice climate too. On mid-summer days the temperature may even get up to freezing point - t-shirt weather. 40 below was more typical though.

January 5, 2012

This might mark a little watershed moment. Although I'll admit to a slight dose of skepticism, just for now. What has happened to make this watershed? In brief, that a large corporate market player has stepped out from under the wing of pharmaceutical company protectionism and made a bold statement in support of food.

The skeptic asks me how long this might remain the case; whether some backpedalling may occur, and wonders at exactly the motivations, but no matter - for now, this is a Good Thing.

For those outside the little loop world of we tubies, enteral feeding devices come in two types - tubes and 'buttons'. Most people, especially for children with tubes, opt for buttons, as they don't dangle about the place. Most buttons are retained by internal water-filled balloons which make them simple to replace at home. The 'button' has now effectively lionized the market. The market is controlled by just two companies, with different varieties of their own products.

"Wherever possible, real food is still the best thing for feeding people, whether they eat the regular way or through a tube."

This is a BIG call. I have seen device manufacturers' literature saying that their devices are suitable for enteral formula and blenderized foods before, but never have I seen a corporation, one of the Big Medicine Corps, effectively say to the entire marketplace that food is better than formula if you can do it. Can they get away with it for long, do you think, before someone at Big Pharma takes countermeasures?

Of course, such countermeasures have long been in place against using food for tube feeding, ever since a reliable and sanitary product that could be shown on paper to provide a spectrum of nutrients suitable for theoretical human life that could be profitably sold was created. It's called education. Doctors and dietitians are busy, time-poor people, who often feel under-rewarded for the long and arduous hours they put in at humanity's service, and despite the canniness of many of them, they are vulnerable to slick messaging from the only people with deep enough pockets to provide most of their free, ongoing postgraduate education - the Pharma Corps. I do not mean to completely belittle the value of such education - of course they need to keep up with developments and changes in science and best practice, and for the most part it is pharmaceutical company funding that drives the research and innovation. They also put on very nice dinners (I should know, I've hosted enough of them).

But food has no such champion. Big Food certainly throws it weight around the mass market and leans heavily on governments around the world to get their bidding done, but the tubie market is too small. But we're a VERY lucrative market for Big Pharma. Also, for AMT and their competition. Naturally, they want the goodwill of the fastest-growing market segment of the fast-growing tubie market.

Still, I congratulate those at AMT with the stones to make this call, even if for now it is just on one part of their website. They kindly link directly to our sister site (where many of this bog's posts are reproduced and I am a co-administrator also), blenderizeddiet.net.

Here's to the notion that this might be a key moment in the opening up of the thinking of the medicalized world of tube feeding. That one day, we might see food on an equally-respected footing with enteral formulae as an option, as well-supported and accepted if not more so, in the medico-industrial complex.

It's not too much to hope for, is it?

EDIT UPDATE: I have just been informed by AMT's marketing manager Lisa Szpak that they have amended their website, saying that "the wording on the website is what you requested to best describe blenderizeddiet.net". I understand that Beverly Hanset-Burch, our co-admin there, previously provided them with some information they could use. Lisa went on to say "AMT does not currently have a position regarding real food versus formula. Nor are we aware of any movement by pharmaceutical companies or device manufacturers regarding real food versus formula. I apologize for any confusion this may have caused. We have modified our website to more accurately represent the subject matter of your website."

Sadly, my fears proved founded then. They have bailed on us regards any endorsement.

December 21, 2011

For those unaware, recent times have seen the second-top definition of the word 'crunchy' in most dictionaries as "politically and environmentally liberal" (as in "music that incorporates whalesong sounds pretty crunchy to me"). Or this, more fully from urbandictionary.com - "Used to describe persons who have adjusted or altered their lifestyle for environmental reasons. Crunchy persons tend to be politically strongly left-leaning and may be additionally but not exclusively categorized as vegetarians, vegans, eco-tarians, conservationists, environmentalists, neo-hippies, tree huggers, nature enthusiasts, etc. " Apparently the etymology of it goes back to a commonly-used phrase in certain circles in the US - shortened from "crunchy granola people".

Lately I've copped a bit of (mostly good-natured) flak about the crunchy nature of most of my blends. Fair call, and being Australian I am all for the sort of well-meaning stirring we often charmingly refer to as "shit-giving", since being vile to each other and heaping insult and deprecation on our close friends and loved ones proved a valid means of overcoming the torpid emotional stifling and suppression that came with the English part of our foundation. We're not quite so comfortable with declarations of love as we are with personal insult. So when you meet an Australian, and when they first call you a bad word, then you know they like you a lot and have accepted you as a friend - just so as you know, OK? You silly bastard.

So anyway, yes, my take on things nutritional is unapologetically a bit on the crunchy side. Like a hippie into top-fuel drag racing though, I also wholeheartedly approve of Nigella Lawson's ridiculously consumption-oriented antics in the kitchen in that her message at heart is about joy and love and the shortness of life. She just expresses it differently from the way I do, is all.

An oft-commented-upon phenomenon when people begin a blended Tube Food journey is the dawning of awareness of food in a whole new way - whether we are blending for ourselves or someone in our care. In fact, it especially applies to parents of small children. What happens, by simple virtue of putting stuff into a see-through container and turning it effectively into stomach contents minus the lumps and digestive juices is that we see and smell what a whole meal is really like, down at 'gut' level. Of course there's the informational approach as well to do our heads in; just in case the blender wasn't illustrative enough. We read the ingredients on a can of formula, are perhaps a little horrified as we fully understand what it is humans are being asked to subsist on, solely, for the foreseeable future. Then when we go to replace that with a 'regular' store-bought sort of pre-packaged meal (such as we'd happily eat at home), reading the ingredients and scrutinizing the caloric values and nutritional breakdowns gives us another pause for thought. So many unnatural chemicals, so much fat, sugar, salt, so highly denatured and processed...........but it's still OK because it isn't formula; that still makes it OK as Real Food doesn't it?

That, friends, is for each one of us to decide.

My last post here was all about choosing better over best, and why it's a sensible approach. I stand by it, as I stand by Nigella's genuine quest to enhance our enjoyment of all things foody. But my journey, and that of many tubies and tubie carers, takes a different path; one more akin to entering the food, to accepting the axiom "you are what you eat" as more than just a throwaway line. This runs the risk of being seen as very crunchy indeed.

We tubies tend to be an unwell lot on average, it must be said. I mean there are reasons we have tubes, it's not a lifestyle choice for most of us. And when you take the connection between nourishment and wellness, then it's hard to turn away from. The burden of such knowledge, that you can almost without any doubt make a huge difference on your spectrum of ill-health to good-health just by changing your diet, is a heavy one, unless acted upon with some grace. Admitting that our average diet is frankly an unsustainable horror and abomination to the planet and our health is hard. It means changing our ways. Facing up to things. Admitting we have been conned, perhaps.

But all too easily, steps on the road to this awareness can feel just so relentlessly negative, and this demotivates many of us. Such negativity is often cited as a reason to shy away from falling in with the crunchy brethren and settling for more of the 'regular' normative diet of Homo Microwavicus. I'm referring to the set of discoveries that those seeking information about food and health make very early on - that pretty much everything that you used to think of as 'food' gives you cancer, heart disease, diabetes, makes you obese, is addictive, messes with your mood and stunts your intelligence. Etcetera. It can seem like it's an all-or-nothing venture, either you become a sandal-wearing vegan self-sufficient organic solar power producer and join the ranks of the annoyingly self righteous or you just shy back from the enormity of the whole modern diet catastrophe and settle down to a big dish of nice consoling 'low-fat' chocolate and bacon icecream. I know many people are simply put off by the mention of a whole grain, an organic vegetable, a mung bean. And anyway, isn't it all like really hard work?

This last myth is the one I want to bust today. That using good whole foods is difficult, that *cooking* in itself is hard, takes loads of time, and is expensive. Baloney.

Double baloney if you have a good blender at your disposal. Many folks new to the idea of a blenderized diet start from the premise that food will need to be treated in very certain and specific ways to be safely used in a tube. Not so; in fact, quite the contrary. I found that getting to know my Vitamix was one of the most liberating things I'd ever experienced with food. Simply put - I can blend anything. Paradoxically, this makes it easy to just throw in some Carnation Instant Breakfast, skim milk powder, Cheerios and perhaps a Twinkie and be done with it. Just as easy is opening a can of formula, and the formula would be arguably better for you too. But the real possibilities such a blender opens up are awesome - if you're cooking a healthy meal for the family then that can go right in the blender too. How simple is that? Any food you can think of to eat in the whole world - you can blend it.

Maybe you've done a bit of reading, and been inspired to go down the local market and buy some bulk whole grains, or legumes. Maybe you live in a food desert and have to travel to get such things, so you stock up - all good. You've discovered that frozen vegetables are not only often better quality than 'fresh' from the supermarket but way cheaper too. Perhaps you've gotten word around with friends and decided that if you all pool together you can buy half a grass-fed organic cow, have it butchered, divided between you and put up in the freezer. These things all make crunchy so much cheaper than the cheapest junk food it's beyond belief. Rice and beans or any grains, chosen well, with a little bit of some good fats, some vegetables, maybe some animal parts or secretions, that's the foundations we're talking about. And if you only look at the adventure from a tube Food perspective, then the whole area of cooking becomes suddenly ten times easier. Why? Because it just doesn't matter how it looks, what it tastes like, or whether you cooked it totally 'right'. It's pretty much impossible to fail.

Crunchy really is just as quick as the alternative, but there's a catch - crunchy usually means waiting. Rice takes a little while to cook. Soaking beans is a really good idea, so you'll find yourself spending a whole 120 seconds (that's two minutes) getting out a bowl and some water the night before. Job's already half done then, you see. Inventions like rice cookers and slow cookers make it so amazingly simple and easy to prepare too. Grains, beans, vegetables, meats, whatever - in the crock. Set. Come back 3 or 4 hours later and blend. That was 15 minutes of your life, just spread over a morning or afternoon. And the rewards? You've spent less cash (if you've shopped or grown well and wisely), gotten tastier food, better nutrition, a sense of providing and accomplishment, and taken less time than wrangling a bunch of cans/jars/plastic packets, microwaves and other gear, plus you've been quite a bit kinder to the environment. But there are TWO extra benefits that come from this, neither of which seem obvious in the face of the other.

One, every step you make towards a more naturalistic and 'whole' crunchy approach to food makes every other step that more inviting, that bit more inspiring and easier, as you discover new sensations and flavours, and gain confidence. Of course, noticing great health improvements can be pretty motivating as well. But number two, opposite to this and just as important, you'll probably come to care far less about the occasional 'bad' food choice episode. You'll stop feeling such guilt at consuming a processed convenience or indulgent luxury food here and there. You'll recognize you're making a certain trade-off between your momentary sense of wellbeing (it was late, convenient, and it's a tasty treat for the family etc) and your desire to feed your tube or your tubie as healthfully as possible. Why? Because you'll have the satisfaction of knowing that all that other crunchy stuff you're doing is making up for such stuff. You can have your Nigella Lawson moments and buy the extravagantly enriched dark chocolate nibblies without overly worrying about the transnational corporation's probable use of child labour or the empty fat-forming calories because you'll have realised by now it's impossible to 100% avoid doing all harm all the time, and because your choices are, for the most part, very responsible ones. Importantly, that does something very profound to the food we eat (and the food we tube), I believe, or at least to how we assimilate it in ourselves.

How we feel about our food and tube food is just as important as the food itself, in my small and humble opinion. If it's a burden, if there's a sense of stress, and it all comes down to being a chore - and if we doubt its goodness and whether it's the 'right' thing, then we are doing ourselves a great disservice. Stress and worry are the biggest and most easily remedied influences on digestive health there are, and they're incredibly infectious. A carer's stress will translate to a tubie's distress, without a word said or a mention made. Just as if we're worrying about whether the processed comfort food we're eating is making us fatter and moving us ever closer to diabetes and a coronary before the age of 50 is more sure to make it so than being less worried, because the stress itself is bad for your heart and wreaks havoc with your digestion. The worry itself creates that great, terrible feedback loop of nihilism - the one that returns you to the sofa with the soda, the chemically-enhanced 1500 cal popcorn with 1000% of your rdi of sodium, and the triple-choc fudge.

Better really is so much better than best in all this too. Making a move in the crunchy direction not only makes further moves easier, but it makes 'retrograde' decisions less stressy too. And you'll find over time you make fewer of those processed convenience-food type choices anyway, but enjoy them all the more because of it.

Nigella's hardly the role model for crunchy healthful planet-loving sustainable foodiness, but she's got one thing nailed for sure - genuine enjoyment is at least half the picture.

And since you're reading this here, chances are very high you already know the broad benefits of the Crunchy, and the major horrors of the slick, corporatized consumerist Smooth. So your choice is fairly (or perhaps unfairly) clear - embrace a bit of a crunchwards direction in your food and tube life, or be prepared for the pressure and stress of your resistance to make you feel worse and more disconnected as time goes on.

I believe in the end that natural selection-type pressures will prevail over our dietary and lifestyle mistakes anyway. We will all die too, of course; so in the light of this mortal reminder the only real question is this: